Management of hematogenous osteomyelitis in children in Douala, Cameroon: diagnostic challenges, complications, and perspectives for improvement

Abstract

Background Pediatric hematogenous osteomyelitis remains a major cause of morbidity in low-resource settings. In Douala, Cameroon, delayed diagnosis and comorbid conditions contribute to severe disease and unfavorable outcomes. Methods We conducted a retrospective cross-sectional study of children aged 0–15 years diagnosed with hematogenous osteomyelitis in five referral hospitals in Douala between January 2017 and December 2024. Sociodemographic, clinical, microbiological, therapeutic, and outcome data were collected. Univariate analysis was performed using odds ratios (OR) with 95% confidence intervals (CI), and variables with p < 0.20 were entered into a multivariable logistic regression model to identify independent predictors of unfavorable outcome. Results Among 306 pediatric osteoarticular infections, 102 were osteomyelitis and 81 met inclusion criteria. The mean age was 6.88 ± 3.98 years, with male predominance (sex ratio 1.79). Consultation was delayed beyond three months in 48.1% of cases. Blood cultures were positive in 21.6%, while focal cultures were positive in 71.1%, with Staphylococcus aureus as the predominant pathogen. Sickle cell disease (SS genotype) was identified in 25.9% of the cohort. Surgical management was required in 46.9% of patients, mainly in chronic forms. Complications occurred in 25.9% of cases. Independent predictors of unfavorable outcome included consultation delay >3 months (aOR 19.65), previous osteomyelitis (aOR 15.08), sickle cell disease (aOR 7.18), chronic osteomyelitis (aOR 4.54), functional impairment (aOR 2.99), abnormal ultrasound findings (aOR 3.69), and prolonged antibiotic therapy >3 months (aOR 14.88). Conclusion Pediatric hematogenous osteomyelitis in Douala remains frequent and severe. Delayed consultation and sickle cell disease are major determinants of poor prognosis. Early diagnosis, strengthened microbiological capacity, and multidisciplinary management are essential to improve outcomes.